15D0910665 CLIA NUMBER - MEDSTAT LLC

Laboratory Demographics

  • CLIA Code: 15D0910665
  • Facility Name: MEDSTAT LLC
  • Facility Address: 1500 PROVIDENT DR STE A
    WARSAW, IN
    ZIP 46580
  • Facility Phone: 219 372-7637
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SCOTT H. EHMEN
  • NPI Number: 1437689783
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0910665
LAB Type Physician Office
Facility Name MEDSTAT LLC
Street 1500 PROVIDENT DR STE A
City WARSAW
State IN
ZIP 46580
Phone 219 372-7637
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2025
Certificate Expiration Date 8/5/2027
Facility Type Physician Office
Lab Director SCOTT H. EHMEN

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This page was last updated on: 9/29/2025